{"title":"住院老年患者谵妄的全球发病率和流行率及其风险因素：系统回顾与荟萃分析","authors":"Chia-Rung Wu , Kai-Mei Chang , Victoria Tranyor , Hsiao-Yean Chiu","doi":"10.1016/j.ijnurstu.2024.104959","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Delirium is a common complication among older medical patients that can lead to undesirable outcomes.</div></div><div><h3>Objectives</h3><div>This study systematically investigated the incidence, prevalence, and risk factors of delirium to improve its recognition, prevention, and management in medically hospitalized older patients.</div></div><div><h3>Methods</h3><div>The study protocol was registered at PROSPERO on April 29, 2024 (registration number: CRD42024536624). We searched the PubMed, Embase, and ProQuest databases for relevant articles published between database inception and September 25, 2024. We included observational studies reporting the prevalence, incidence, and risk factors of delirium among medically hospitalized older patients. Two independent reviewers extracted the data. A random-effects model was used for data analysis.</div></div><div><h3>Results</h3><div>A total of 35 studies encompassing 12,097 participants met the inclusion criteria, yielding a 23.6 % pooled prevalence of delirium (95 % confidence interval = 19 % to 29 %) and a 13.5 % pooled incidence of delirium (n = 32, 95 % confidence interval = 11 % to 17 %) among medically hospitalized older patients. Study quality and country were significant moderators for explaining the heterogeneity observed in the prevalence and incidence of delirium, respectively (both P < 0.001). The risk factors of delirium included frailty (odds ratio = 2.05), physical restraints (5.01), prior falls (1.99), severe illness (1.32) (evaluated using the Acute Physiology and Chronic Health Evaluation II), and cognitive impairment (2.61). Older age increased delirium risk, whereas years of education mitigated it (B = 1.69 and 0.92, respectively).</div></div><div><h3>Conclusion</h3><div>Our findings considerably enhance the understanding of the prevalence of delirium and its influencing factors in medically hospitalized older patients. The insights this study provides can enable health-care providers to apply quick and effective assessment tools and can thereby support the implementation of interventions to prevent delirium.</div></div><div><h3>Registration</h3><div>The study protocol has been prospectively registered on PROSPERO (registration no. CRD42024536624).</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"162 ","pages":"Article 104959"},"PeriodicalIF":7.5000,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Global incidence and prevalence of delirium and its risk factors in medically hospitalized older patients: A systematic review and meta-analysis\",\"authors\":\"Chia-Rung Wu , Kai-Mei Chang , Victoria Tranyor , Hsiao-Yean Chiu\",\"doi\":\"10.1016/j.ijnurstu.2024.104959\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Delirium is a common complication among older medical patients that can lead to undesirable outcomes.</div></div><div><h3>Objectives</h3><div>This study systematically investigated the incidence, prevalence, and risk factors of delirium to improve its recognition, prevention, and management in medically hospitalized older patients.</div></div><div><h3>Methods</h3><div>The study protocol was registered at PROSPERO on April 29, 2024 (registration number: CRD42024536624). We searched the PubMed, Embase, and ProQuest databases for relevant articles published between database inception and September 25, 2024. We included observational studies reporting the prevalence, incidence, and risk factors of delirium among medically hospitalized older patients. Two independent reviewers extracted the data. A random-effects model was used for data analysis.</div></div><div><h3>Results</h3><div>A total of 35 studies encompassing 12,097 participants met the inclusion criteria, yielding a 23.6 % pooled prevalence of delirium (95 % confidence interval = 19 % to 29 %) and a 13.5 % pooled incidence of delirium (n = 32, 95 % confidence interval = 11 % to 17 %) among medically hospitalized older patients. Study quality and country were significant moderators for explaining the heterogeneity observed in the prevalence and incidence of delirium, respectively (both P < 0.001). The risk factors of delirium included frailty (odds ratio = 2.05), physical restraints (5.01), prior falls (1.99), severe illness (1.32) (evaluated using the Acute Physiology and Chronic Health Evaluation II), and cognitive impairment (2.61). Older age increased delirium risk, whereas years of education mitigated it (B = 1.69 and 0.92, respectively).</div></div><div><h3>Conclusion</h3><div>Our findings considerably enhance the understanding of the prevalence of delirium and its influencing factors in medically hospitalized older patients. The insights this study provides can enable health-care providers to apply quick and effective assessment tools and can thereby support the implementation of interventions to prevent delirium.</div></div><div><h3>Registration</h3><div>The study protocol has been prospectively registered on PROSPERO (registration no. CRD42024536624).</div></div>\",\"PeriodicalId\":50299,\"journal\":{\"name\":\"International Journal of Nursing Studies\",\"volume\":\"162 \",\"pages\":\"Article 104959\"},\"PeriodicalIF\":7.5000,\"publicationDate\":\"2024-11-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Nursing Studies\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0020748924002724\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"NURSING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Nursing Studies","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0020748924002724","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"NURSING","Score":null,"Total":0}
Global incidence and prevalence of delirium and its risk factors in medically hospitalized older patients: A systematic review and meta-analysis
Background
Delirium is a common complication among older medical patients that can lead to undesirable outcomes.
Objectives
This study systematically investigated the incidence, prevalence, and risk factors of delirium to improve its recognition, prevention, and management in medically hospitalized older patients.
Methods
The study protocol was registered at PROSPERO on April 29, 2024 (registration number: CRD42024536624). We searched the PubMed, Embase, and ProQuest databases for relevant articles published between database inception and September 25, 2024. We included observational studies reporting the prevalence, incidence, and risk factors of delirium among medically hospitalized older patients. Two independent reviewers extracted the data. A random-effects model was used for data analysis.
Results
A total of 35 studies encompassing 12,097 participants met the inclusion criteria, yielding a 23.6 % pooled prevalence of delirium (95 % confidence interval = 19 % to 29 %) and a 13.5 % pooled incidence of delirium (n = 32, 95 % confidence interval = 11 % to 17 %) among medically hospitalized older patients. Study quality and country were significant moderators for explaining the heterogeneity observed in the prevalence and incidence of delirium, respectively (both P < 0.001). The risk factors of delirium included frailty (odds ratio = 2.05), physical restraints (5.01), prior falls (1.99), severe illness (1.32) (evaluated using the Acute Physiology and Chronic Health Evaluation II), and cognitive impairment (2.61). Older age increased delirium risk, whereas years of education mitigated it (B = 1.69 and 0.92, respectively).
Conclusion
Our findings considerably enhance the understanding of the prevalence of delirium and its influencing factors in medically hospitalized older patients. The insights this study provides can enable health-care providers to apply quick and effective assessment tools and can thereby support the implementation of interventions to prevent delirium.
Registration
The study protocol has been prospectively registered on PROSPERO (registration no. CRD42024536624).
期刊介绍：
The International Journal of Nursing Studies (IJNS) is a highly respected journal that has been publishing original peer-reviewed articles since 1963. It provides a forum for original research and scholarship about health care delivery, organisation, management, workforce, policy, and research methods relevant to nursing, midwifery, and other health related professions. The journal aims to support evidence informed policy and practice by publishing research, systematic and other scholarly reviews, critical discussion, and commentary of the highest standard. The IJNS is indexed in major databases including PubMed, Medline, Thomson Reuters - Science Citation Index, Scopus, Thomson Reuters - Social Science Citation Index, CINAHL, and the BNI (British Nursing Index).
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